PURPOSE OF THE JOBThis position supports performance measure monitoring and improvement functions for the Medicaid Segment's managed care organization. The role oversees performance measures across the organization and provider network for both behavioral and physical health care. Responsibilities include monitoring, reviewing, and evaluating performance measure data and technical specifications. This position must reside in Arizona within the Geographical Service Area to meet contract compliance requirements.
QUALIFICATIONSREQUIRED QUALIFICATIONSWork Experience:
- 5 years of experience in the health care payer or provider space
Education:
Licenses:
Certifications:
PREFERRED QUALIFICATIONSWork Experience:
- 10 years of healthcare experience, preferably within the Arizona Medicaid system
- Experience leading system-wide interdisciplinary improvement projects
Education:
- Master's degree in business, healthcare administration, or related field
Licenses:
Certifications:
- Certified Professional in Healthcare Quality (CPHQ) or CHCQM preferred
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES- Drive performance improvement for NCQA HEDIS and other quality metrics
- Develop and implement system-wide performance improvement projects
- Develop and monitor Corrective Action Plans and evaluate effectiveness
- Collaborate with internal departments (Quality Management, Performance Improvement, Quality Analytics) to ensure data integrity
- Supervise staff performing performance improvement and monitoring functions
- Report performance outcomes to leadership, regulators, and stakeholders
- Analyze data and communicate insights and recommendations to internal teams and provider agencies
- Monitor and track provider performance to identify trends, issues, and compliance gaps
- Develop intervention strategies to improve outcomes and ensure compliance with contractual requirements
- Conduct research, analyze data, and produce reports and recommendations
- Attend meetings with AHCCCS, provider agencies, and other stakeholders as needed (travel required)
- The position has an onsite expectation of 1 day per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
- Perform other duties as assigned
COMPETENCIESREQUIRED JOB SKILLS- Subject matter expertise in NCQA HEDIS and CMS Core performance measure methodologies
- Experience working with Medicaid managed care organizations
- Proven ability to collaborate with executive leadership across complex organizations
- Strong experience in data analysis, reporting, and presentation (written and verbal)
- Excellent analytical and problem-solving skills
- Ability to build trust with diverse stakeholders
- Strong interpersonal, collaboration, and communication skills
- Proficiency in Microsoft Office applications (Word, Excel, PowerPoint, MS Project)
- Ability to maintain confidentiality and protect sensitive information
REQUIRED PROFESSIONAL COMPETENCIES- Strategic and consultative program management approach
- Strong analytical skills with ability to identify root causes and solutions quickly
- Ability to work independently and make confident decisions
- Flexibility to adapt to changing priorities
REQUIRED LEADERSHIP COMPETENCIES- Confidence working with all levels of internal and external stakeholders
- Collaborative and motivational leadership style
- Ability to manage sensitive and confidential situations professionally
PREFERRED COMPETENCIESPreferred Job Skills:
- Advanced proficiency in Microsoft Office and experience with Daptiv preferred
Preferred Professional Competencies:
Preferred Leadership Competencies:
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.
